Individual
LISA TUNGOVIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MILE POST 388, POLACCA, AZ 86042
(928) 734-6000
Mailing address
HWY 264 MILE POST 388, POLACCA, AZ 86042
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
899436
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
01/21/2016
Last updated
01/21/2016
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